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HomeMy WebLinkAboutMiscellaneous - 65 PRESCOTT STREET 4/30/2018 65 PROSPECT STREET 210/080.0-0009-0000.0 4 � I i Date....... 7 h:.�. .................. OF p&ORT�y o? W- TOWN OF NORTH ANDOVER h � 9 PERMIT FOR GAS INSTALLATION SsgCHUs� This certifies that .........P...P..rjc�............. ............................................. has permission for gas in tallat on .......� � ....... inthe bu ldi sof.......... .................................................................. at....�-f' .... .. Q.`2 ': k.......... ................. North Andover, Mass. Fee... . .......... Lic. No. t l;56. 5..... �r..................................................... GASINSPECTOR Check#� 09896 -` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK _. .: - CITY rJoRT�S_%a,�po MA DATE...-. y f 5 �PE. b� G JOBSITE ADDRESS reSLo 1T ST OWNER'S NAME OWNER ADDRESS 11TE =— FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDURESIDENTIAL � EDUCATIONAL(� CLEAP,LY NEW:Q RENOVATION:El REPLACEMENT:[3— PLANS SUBMITTED: YES NO[R— APPLIANCES 1 FLOORS- BSM 1 2 3 � 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER _ COOK STOVE DIRECT VENT HEATER DRYER - FIREPLACE FRYOLATOR FURNACE GENERATOR �— GRILLE INFRARED HEATER__......_..�.� — LAB ORATORY COCKS MAKEUPAIRUNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOFTOP UNIT TEST UNIT HEATER UN!,.ENTED ROOM HEATER WATER HEATER OTHER et ti ahoy v v t INSURANCE COVERAGE - 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0<0 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ® BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONL : OW AGENT SIGNATURE OF OWNER OR AGENT 1.hereby certify that all of the details and information I have submitted or entered regarding.this application are t n urat e #of my knowledge and that all plumbing work and Installations performed under the permit issued for this application will be in co plian th all ne ovision of the . Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME I Sr. JLICENSE# 156Y USlq4ATURE MP E3'MGF® JP ® JGF© LPGI CORPORATION RTNERLIPE]#L it LLC��- COMPANY NAME: ee 8ro ADDRESS — CITY �a�-( _ ( STATE ZIP Z f Z 2 TEL FAX CELL �EMAIL �eer�e �� r y t { . \� C� E M IONW pF MA$ 1GH115 7T k • ' . S' PLUMgE R, ISSUES RSH � SF I TTE{ kQWI S F� N' L I CS THAs PA LAN 1+fG L7�£EUSE MASTER' moi: P L Uht'B ESR � A1(,IFtsW GARF . n e 'R© KT+pN W phtsA0 > / IS04.5 �3o`t 14 a y;. ,X26 � 4.42 s< o COM(NONWEA JHa OF MAS J#t%H.I SETS • r . . . • INW BGARI PLUh1BERS` Alb G'ASF#1TE" S `1 SSUES THE FOE LOWI INGVLI CENSE 3�i F ., REG&IaST M AS A PLUMWI' C�"COI�Pn �OAVlO 'W GARFIELD �� C7 r ,. ..' ..VINE`( BRQT'1, - >S 'SERVt GE, L L ... 1Z 2 t W I L'L�QW{ STS afi ��, ry f v 9RQKTbN s °MA 02301 2t 36 ` T05 2 .4t3 At FEENBRO.01 SMORAN �� C�RTIEICA►TE OF LIABILITY INSURANCE DATE 1!(MhUDD(MMlDDIYYYY)-- 5 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Ileu of such endorsement(s). PRODUCER CONTACT NAME: Rogers 8 Gray Insurance Agency,Inc. PHONE FAX (877)816-2156 434 Rte 134 Arc No Exit: AIC No South Dennis,MA 02660 ADDRESS: INSURER(S)AFFORDING COVERAGE MAIC IksuRERA:OId Republic General Insurance Corp. 24139 INSURED INSURER B Feeney Brothers Services LLC INSURERC: 103 Clayton St PO Box 220801 INSURER D Dorchester,MA 02122 INSURER E. INSURER F,. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOWHAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER MMIDDJYYYY) (MMfDD1YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00DAMAGE TO RENTEr7 ' CLAVAS-MADE ff]OCCUR A2CG0750150i 02101/2015 02101/2016 PREMISES Eaoccurrenca $ 300,00 1.1 ED EXP(Any oneperson) $ 10,00 PERSONALBADVINJURY S 1,000,00 GEN'LAGGREGATELIMITAPPUESPER: GENERALAGGREGATE $ 2,000,00 � PRO- POLICY . LOC PRODUCTS-COMPIOP.AGG 5 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ " Ea accident ANY AUTO BODILY INJURY(Per person) $ ALLOANED SCHEDULED - AUTOS AUTOS BODILY INJURY(Peraxidenl) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS tPer accident $ $ UMBRELLA UABOCCUR EACH OCCURRE&IGE $ EXCESS LIAR HCLAJP.IS-?.(ADE AGGREGATE $ OED I I RETENTIONS $ WORKERS COMPENSATION - X I PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER A ANY PROPRIETOWARTNERJEXECUTIVE YIN 2CW07501601 02/0112015 02/01/2016 E.L.EACH ACCIDENT S 1,000,00 OFFICERR.49.18ER EXCLUDED? NIA (MandatorylnNH) E-L.OISEAS£-EA EMPLOYEE S 1,000,00 DUO under SCRIPTIONOFOPERATIONS bekrN E.LDIS EASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached It more space Is required) _ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-201471CORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name.and logo are registered marks of ACORD7 Date k N° 4244 NORTH TOWN OF NORTH ANDOVER ° PERMIT FOR PLUMBING ,SSACNusf -r This certifies that • has permission to perform . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . 9 at , �-^- -�. . . :, N ryrth Andover, Mass. Lic. No..Y2- . . !. . . -� % /�- . . . . . . . . PLUMBI&VECTOR WHITE: Applicant CANARY: Building Dept. PINK:Treasurer 9. Si i �. 1=0M .a • c stILL 2 x x s s x 0 o ~i a 3! w w 'sw w M y . sI D o 0 0 0 0 0 "' it r n nl� go ji WATER CLOSETS •. J ' KIT _ OMEN SINKS m LAVATORIES C BATHTUBS UA Z g SHOWER STALLS 0 i DISHWASHERS O DISPOSERS ; $ LAUNDRY TRAYS N WASH. MACH. CONN. m O i g 007 WATERA �9 C A TANKS C.� _ TANKLESS O e� •BSLOP SINKS � a s FLOOR DRAINS N �� "1 CAS TRAPS m� ❑ � 13 URINALS fn DRINKING FOUNTAIN AREA DRAIN W WATER PIPING M O g O � ROOF DRAINS � I Q S BACKFLOW PREV. �, G) ,q a OTHER FIXTURES: 17 S - r n O w to Z z 3 BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS $�ICNIEg FEE PROGRESS INSPECTIONS N0. APPLICATION FOR PERMIT TO DO PLUYBINO HARM t TYPE OF BUILDING LOCATION OR BUILDING PLUMBER PERWT GRANTED DATE---�....�19 PLUMBING INSPECTOR Date... , / _ CJl)..... 3532 i TOWN OF NORTH ANDOVER 3? o ' + PERMIT FOR GAS INSTALLATION f A I 1SSACHUSEt i This certifies that . . .%. . . . . . . . . . . . . . . has permission for gas installation ... . . . . . . . . . . . . v in the building of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . ., North Andover, Mass. „` J Feet, Lic. No.. .7 : . . . . . . . . . . . . . r� GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) LM k1 of T i� A fv bo J ec , Mass. Date la a _19-Z— Permit # Building Location�o S I'LU5 PSL T S}- Owner's Name as C1TT� FV&)62 NoF-I t- A r✓DO✓2-2 ,MA 01S�t!J Type of Occupanry_ New ❑ Renovation ❑ Replacement Plans Submitted: Yesp No ❑ N fA ¢ Z ¢ y Ul M V !� tl WJ ¢ F < } Z Z 0 F.. ¢ < VMA < ¢ ¢ O O = In H N F O ¢ 1A 0W < y W f. Vf d ¢ r < tl �•. Z J F' Z F.. cc WW tl O > W !• W J pN. W W < } M Z O 2 O S m _ w < W > ¢ W 2. < ¢ _< ¢ ¢ 'Z O tl Y U. 3 G tl J V ¢ > G d L~ O SUB-8SMT. BASEMENT !ST FLOOR 2ND FLOOR I 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name "f,r1 A 9 T A . elm MA T v-1�0 Check one: Certificate Address 30 LrpAra 1vt ra.ry L i ❑ Corporation " 7 N U E rJ 01 A U p Partnership Business Telephone lo,1?Z —5747-7 f 2--'Firm/Co. Name of Licensed Plumber or Gas Fitter �2 o(A E P T A- 15 A m,1)i9 7-i4 Po INSL$RANCE COVERAGE: I have a current}ability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes [i-e' No ❑ If you have checkedrtes, please indicate the type coverage b checking the ro riate box 9 Y 9 PP P A liability insurance policy Other type of indemnity❑ Bond ❑ OWNER'S INSURANCE WAIVER: i am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent p I hereby certify that all of the details and information I have submitted for entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the pe i ed for this application be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ne Laws. BY T of License: Plumber n ure of cen u or Fitter Title tter or Uoense Number 9333 �'fT� Journeyman 1 BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING i NAME A TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE - 1 9 OAS INSPECTOR Date. . /. /<:e - .6. L . . . OF ~O H -�`02 �` 0'- TOWN OF NORTH ANDOVER f p PERMIT FOR GAS INSTALLATION SACMUS , This certifies that . . P. . .!. . . .� l'.�. y`:'.`.'... . . . . . . . . . . . . . . . . . has permission for gas installation . . . . . .. . ./.'. .�-.(�!k. . . . . . . . . . . . in the buildings of . . . . . A� . . . . . . . . . . . . . . . . . . . . . . . . . . . . at ., North Andover, Mass. jFee. . . Lic. No..c 4 C . . /,✓z.. . . . . . GAS INSPECTOR Check# 401 t. s MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FTrr] TG (Type or print) Date NORTH ANDOVER,MASSACHUSETTS Building Locations �F' �� /� � - Permit# Amount$ Owner's Name Z .� �� y✓y New❑ Renovation ❑ Replacement ©� Plans Submitted ❑ W O U a7 994 m H O O O E» O E. o A v g A a o SUB-BA.SEM ENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR STH. FLOOR 6TH. FLOOR 7TH FLOOR STH. FLOOR (Print or type) - / /yone: Certificate Installing Company V Name � . .F `/ 1-71 Corp. Address < d1jG� � y` ❑ Partner. Business Telephone CJ 2 rrm/C0. Name of Licensed Plumber or Gas Fitter flU 47 d k- INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes f/ No❑ If you have checked ye—s please indicate the type coverage by checking the appropriate box Liability insurance policy E3-' Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installati undrpter ;44u this applioa. will be in compliance with all pertinent provisions of the Massachus Sta a and the Genera s. Signature of Licensed umber Or Gas Fitter Title By Plumber �U City/Town ❑ Gas Fitter License Number Master APPROVED(OFFICE USE ONLY) 0 Journeyman